Prior Authorization Specialist

Prior Authorization Specialist – Sheridan Memorial Hospital

Join Sheridan Memorial Hospital, a 5-Star rating facility located in the foothills of the Big Horn Mountains, in providing top‑quality, patient‑centered care. Our hospital employs over 750 skilled professionals and serves more than 100 providers across 25 specialties.

Responsible for obtaining and documenting pre‑authorizations for services performed within the hospital and clinics in accordance with payor guidelines, ensuring timely and accurate processing.

• Obtain and document pre‑authorizations/pre‑certifications per payer requirements.
• Verify physician orders and determine CPT, HCPCS, and ICD‑10 codes for prior authorization.
• Understand and communicate insurance co‑pays, deductibles, and out‑of‑pocket expenses for point‑of‑service collections.
• Maintain communication with providers, clinical staff, and patients regarding authorization status.
• Assist billing department with research and resolution of rejected, incorrectly paid, and denied claims.
• Support a professional atmosphere for patients, families, and staff.
• Keep current with insurance pre‑authorization requirements and educate departments accordingly.
• Inform management of changes in authorization processes, policies, and billing requirements.

• High school graduate or equivalent.
• Knowledge of CPT, HCPCS, and ICD‑10 coding (preferred).
• Medical terminology proficiency.
• Strong communication skills with providers, staff, payors, and patients.
• Excellent time‑management, organization, and problem‑solving abilities.
• Proficiency with Microsoft Office (Word, Excel, PowerPoint) and EMR system.
• Ability to maintain confidentiality and work in a fast‑paced environment.

• Competitive salary and benefits package.
• Opportunities for professional development and training.
• Inclusive, supportive, and collaborative work environment.

Sheridan Memorial Hospital is an equal opportunity/affirmative action employer and gives consideration for employment to qualified applicants without regard to race, color, religion, age, sex, national origin, disability, or protected veteran status. Pre‑employment drug and alcohol screening is required.